Abstract
Purpose
Severe lower extremity trauma presents challenges in decision-making in terms of reconstruction or amputation. While injury severity scores have been developed to aid decision-making in adults, evaluation of their use in children is limited.
Methods
Children presenting with severe lower limb trauma from 2000 to 2010 in a major trauma centre were identified from a trauma registry. Records were reviewed for details of the injury, surgical intervention, amputation and scores for the Mangled Extremity Severity Score, Limb Salvage Index, Predictive Salvage Index, Nerve injury, Ischaemia, Soft tissue injury, Skeletal injury, Shock, Age System and the Hanover Fracture Scale 1998.
Results
Twenty children (average age 8.7 years) were eligible for inclusion. There were three primary amputations and no secondary amputations. All of the scoring systems had poor specificity and would have recommended amputation in several limbs that were successfully reconstructed.
Conclusions
Currently available injury severity scores behave differently in children and adults. In their current format, these scores should not be used as an absolute indication for early amputation in children.
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References
Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF et al (2002) An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med 347(24):1924–1931
MacKenzie EJ (2005) Long-term persistence of disability following severe lower-limb trauma. Results of a seven-year follow-up. J Bone Joint Surg 87A(8):1801–1809
Johansen K, Daines M, Howey T, Helfet D, Hansen ST (1990) Objective criteria accurately predict amputation following lower extremity trauma. J Trauma 30(5):568–572
Russell WL, Sailors DM, Whittle TB, Fisher DF, Burns RP (1991) Limb salvage versus traumatic amputation. A decision based on a seven-part predictive index. Ann Surg 213(5):473–480
Howe HR, Poole GV, Hansen KJ, Clark T, Plonk GW, Koman LA et al (1987) Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg 53(4):205–208
McNamara MG, Heckman JD, Corley FG (1994) Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS). J Orthop Trauma 8(2):81–87
Seekamp A, Köntopp H, Tscherne H (2001) Hannover Fracture Scale ‘98–reevaluation and new prospects for an established score system. Unfallchirurg 104(7):601–610
Fagelman MF, Epps HR, Rang M (2002) Mangled extremity severity score in children. J Pediatr Orthop 22(2):182–184
Mommsen P, Zeckey C, Hildebrand F, Frink M, Khaladj N, Krettek C, Probst C (2010) Traumatic arterial injury in children: epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score. J Orthop Surg Res 15(5):25
MacKenzie EJ, Bosse MJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF et al (2000) Characterization of patients with high-energy lower extremity trauma. J Orthop Trauma 14(7):455–466
Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF et al (2001) A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg 83A(1):3–14
Lin CH, Wei FC, Levin LS (1997) The functional outcome of lower extremity fractures with vascular injury. J Trauma 43:480–485
Acknowledgements
The study was supported by the Leslie Eric Paddle Scholarship from the University of Melbourne. The authors would like to acknowledge the contribution of Mary Sheedy.
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Stewart, D.A., Coombs, C.J. & Graham, H.K. Application of lower extremity injury severity scores in children. J Child Orthop 6, 427–431 (2012). https://doi.org/10.1007/s11832-012-0439-6
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DOI: https://doi.org/10.1007/s11832-012-0439-6